The Clinical Pharmacy team work alongside the home ward frailty, and respiratory virtual ward services at Leeds Community Healthcare Trust. The service provided by the pharmacy team has been agreed separately with each service therefore the pharmacy input and processes differ between the services. This guidance takes those differences into account where necessary.

Home ward frailty service

The home ward for frailty (HWF) started as a step-up service in November 2019 and evolved in October 2020 to accept step-down patients from the acute site as it expanded to city-wide provision. The service is consultant geriatrician and consultant practitioner (nurse) led. The pharmacy team provide both remote and domiciliary structured medication reviews and actively contribute to supply of medication, governance and pharmaceutical advice in all MDTs.

A 55-bed ward with 7-day provision 8am to 8pm, currently achieving 40 to 60% occupancy. There are step-up and step-down pathways with a broad referral base. Board rounds are in place Monday to Friday, weekend plans are put in place on at the Friday MDT for every patient, with escalation to the reg or consultant on-call at the acute site if needed.

Home visits are in place, patients are seen within two hours of referral. Electronic prescribing is used, remote monitoring and POCT are not used. Key interventions include initial assessment by a qualified or in training advanced clinical practitioner (ACP), treatment plans, oxygen as required, venepuncture, antimicrobials oral or IV, diuretics oral and IV, therapy, sub cut fluids, referral to therapy, advance care planning and referral to other appropriate services including third sector commissioned Home Comforts provided by AGE UK.

Home ward respiratory

The home ward for respiratory (HWR) is a long established service supporting both step up and step down COPD patients. The service is respiratory consultant and consultant practitioner (nurse) led. The HWR is smaller than the HWF service, with a capacity of approximately 10 beds and 2 MDTs per week (Monday and Thursday). The pharmacy team support the HWR team in their MDT providing mainly remote reviews and general pharmaceutical advice.

Placement hours

Your placement hours will be 9am to 4pm. There may be variation in this depending on which service you are placed with and may change on a daily basis. Some of our colleagues start work at 8am. If you are placed with a team that starts earlier you will be expected to work the same hours as they do.

Travel

You will be expected to be independently mobile at all times during working hours as you may be asked to move between sites for placement opportunities. Where this is not possible, for example, car breakdown, car servicing, please inform your placement tutor as soon as possible to ensure you are supported.

When working with a team, you will not be expected to travel independently to patient visits. Instead, you will travel with the member of staff who is due to see that patient.

Microsoft Teams

Teams is used for all meetings, including MDTs. If you are unfamiliar with teams and require additional training please inform your placement tutor. Please note Microsoft teams is not information governance supported therefore when sharing files and in group conversations ensure no patient identifiable information is used.

You will be expected to have your camera on in all meetings and to introduce yourself in meetings if you have not been introduced by your placement team.

Leeds Community Healthcare Trust offers pharmacy undergraduates a unique opportunity to care for patients in their own homes and shadowing time with a range of healthcare professionals. The exposure to other roles and seeing patients at home helps to showcase how healthcare professionals work to a high level of autonomous practice. You will observe prescribing and decision making in the management of acute and long-term conditions.

Students are expected to:

• be respectful to all healthcare professionals they encounter
• exhibit professional standards at all times
• think reflectively on their experiences during placement and how this will inform their future practice
• undertake clinical observations, under supervision, and structured medication reviews
• independently navigate between clinics and placement sites where necessary

As placements are 4 to 5 days the induction occurs on the first day with the Pharmacy team. The Pharmacy team attempt to come together in one site to welcome the student on placement and spend the first day working alongside each other. During this day the timetable will be shared and discussed and a plan made for the last day of the placement to review learning from the placements. In effect, the pharmacy team “bookend” the placement on the first and last day and in-between try to give students as much exposure to other healthcare professionals and patients as possible.

Undergraduate pharmacy students will be placed in several different clinics and with different clinical specialisms during their placement. Be prepared for working in patients’ homes, travel across the city and in clinics. Previous placements have included neighbourhood teams (such as home visits to patients), podiatry clinic, falls service, Homelessness team, tuberculosis clinic, central intravenous administration service (CIVAS) and Infection Prevention team.

Polypharmacy

• Polypharmacy training

Frailty and cardiovascular disease

• CVD training

Bone health

• National Osteoporosis Guidelines Group UK
• FRAX tool

Chronic kidney disease

• Nephrology dialysis transplantation (Oxford Academic): Ageing meets kidney disease
• NICE Guidance: Chronic kidney disease: assessment and management

Constipation

• RCGP Learning: Constipation in the elderly by Dr Dirk Pilat
• Constipation in older adults, PMC
• Chronic constipation in the elderly: a primer for the gastroenterologist
• Treatment of constipation in older people, CMAJ

Depression

• Age and Ageing (Oxford Academic): Why we need to evaluate long-term antidepressant use in older patients with depression
• British Geriatrics Society: Depression among older people living in care homes report

Diabetes Mellitus

• Diabetes and Frailty: An expert consensus statement on the management of older adults with type 2 diabetes

Dysphagia

• Swallowing difficulties (Specialist Pharmacy service): The first stop for professional medicines advice
  See also dysphagia factsheet under malnutrition

Falls

• World guidelines for falls prevention and management for older adults: A global initiative
• Orthostatic (postural) hypotension

Incontinence

• Age and Ageing: Promoting continence in older people
• Appropriateness of oral drugs for long-term treatment of lower urinary tract symptoms in older persons: Results of a systematic literature review and international consensus validation process (LUTS-FORTA 2014)

Infections

• Approach to infection in the older adult
• Journal of Pharmacy Practice and Research: Principles of assessment and management of urinary tract infections in older adults (Godbole, 2020)
• Pneumonia (community-acquired): Antimicrobial prescribing (NICE Guidance)
• Urinary tract infection (lower): Antimicrobial prescribing (NICE Guidance)

Malnutrition

• Managing adult malnutrition in the community: Malnutrition pathway includes specific advice for malnutrition in certain conditions and areas, for example, care homes, dysphagia, falls
• Bournemouth University: Optimising food and nutritional care for people with dementia

Stroke

• Stroke and transient ischaemic attack in over 16s: Diagnosis and initial management (NICE Guidance)

Dementia

• Dementia OPMH guidance for PCNs and care homes
• Managing neuropsychiatric symptoms in patients with dementia, The BMJ
• Antipsychotic prescribing toolkit for dementia

• Evidence-based clinical practice guidelines on the management of pain in older people: A summary report by Patricia Schofield, Margaret Dunham, Denis Martin, Gary Bellamy, Sally-Anne Francis, Dave Sookhoo, Antonio Bonacaro, Eshtar Hamid, Rebecca Chandler, Aza Abdulla, Mike Cumberbatch, Roger Knaggs, 2022
• An Algorithm for Neuropathic Pain Management in Older People, SpringerLink
• Journal of Pharmacy Practice and Research: Management of persistent pain in older people (Hall, 2016)

Parkinson’s Disease

We expect you to attend 100% of sessions on the programme as a mark of respect for your colleagues and particularly your patients. Failure to attend, or absence without permission, can have serious consequences and may result in you being excluded from the university.

If you are unwell and unable to attend any of the clinics allocated in your timetable, please contact the Medical Education team at lcht.medicaleducation@nhs.net to let them know as soon as possible, and notify your placement office.

When at work you are expected to have a professional appearance at all times. You are expected to wear scrubs at all times.

When visiting patients in their own home you are expected to follow LCH dress code and Covid 19 policies. Gloves, masks, face screens, aprons and alcohol gel are available from all LCH neighbourhood team offices and will be provided by the team you are working with.

Course Evaluation
We are open to suggestions for improving this clinal placement, please complete the short placement questionnaire that will be circulated to you via email at the end of your placement at LCH. You can also provide feedback when completing your evaluation forms via the medical school. Please also feel free to let the Medical Education team (med ed email) or Clinical Pharmacy team (lcht.frailty-home-ward-pharmacy@nhs.net) know directly how you are finding the placement or to raise any concerns or suggestions with them.